Giving up cigarettes can be much harder for some smokers than others.
Dr. Kirk Flury, a specialist in pulmonary medicine who helps with the smoking cessa-tion classes at St. Joseph Hospital of Kirkwood, says one-third to 40 percent of smokersare nicotine-dependent.
“Even though they go through behavioral changes, they reach asignificant barrier to stopping smoking,” Flury said. “They havetrue symptoms of drug withdrawal. This is a resistant group inca-pable of stopping, and this is where nicotine replacement comesin.”
Like an alcoholic or heroin addict attempting to kick the habit, thenicotine-dependent smoker trying to stop “cold turkey” sufferssymptoms including agitation, nervousness, loss of concentrationand the inability to sleep.
Over-the-counter aids such as nicotine patches, gum, lozenges and inhalers can help thisgroup, Flury said. A prescription drug that has proven beneficial is the antidepressantbupropion. It does not seem to have side effects when taken by people who are notnecessarily depressed, Flury said.
“Working with patients like this, you probably don’t get double-digit success rates un-less you add replacements,” he said. “The combination of nicotine replacement andbupropion yields cessation rates between 25 to 40 percent.”
Flury said some studies show people in this group begin smoking to manage stress orcalm anxiety.
“They tend to be addiction-prone,” he said. “There’s a high use of tobacco in peopleaddicted to other drugs also. It may be that nicotine in these patients serves as an antide-pressant or mood modulator.”
“When nicotine is taken away, they have difficulty with the stress and anxiety of dailyexistence. The presence of nicotine in some people’s brain chemistry is an importantingredient in their day-to-day functioning.”
To help nicotine-dependent smokers break the habit, you must separate them from thealmost ritualistic behavior of smoking - lighting a cigarette every time they have a cup ofcoffee, for example - and give them a nicotine replacement such as the patch.
“Then you can start working on the issues of gradually withdrawing the nicotine they’regetting from their patches,” Flury said.
The nicotine replacements seem to have the added benefit of preventing the weight gainthat some people experience when they stop smoking.
“It allows them to gain less weight or no weight,” Flury said. “It helps them control theeating urges that come with not smoking.”
And, over the long run, it’s cheaper. Consider the priceof a pack of cigarettes and multiply that by pack perday, days per week, weeks per year and you’ll get a bignumber. Many smokers report quitting just because ofthe expense.
One 21 year old college freshman put it this way: “Iwas spending over $2,000 a year on cigarettes! When Ithought about all the other things I could do with thatmoney.well, I quit right then.”
Nicotine itself is not harmful, Flury said: “It’s the delivery substance through tobaccothat’s harmful. The coronary artery disease and cancers are related to the tars and car-cinogens in tobacco smoke.”
Although tobacco use is still too prevalent, Flury said, there has been great success inchanging the public perception of smoking.
“Everybody used to smoke,” he said. “I remember the old ads from the 1940s, a doctorin his office at the end of the day smoking a Camel. ‘Your doctor smokes Camels, youshould, too.’ That’s how far we’ve come.”
The American Cancer Society cites 180,000 reasons to quit smoking - the number of
cancer deaths in this country attributed to tobacco use in 2003. Lung cancer is the lead-ing cause of cancer deaths in the United States for both men and women, and 87 percentof lung cancers are blamed on smoking cigarettes, cigars or a pipe.
The American Cancer Society offers these tips for quitting smoking:
1. Consider using medication to help you quit, such as prescription and over-the-counter
drugs that help you deal with withdrawal symptoms or help reduce the urge to smoke.
2. Enlist support. Call the American Cancer Society at 1-800-227-2345 or visit
www.cancer.org to find free or low-cost counseling services.
3. Get help or ask for help from your health care provider.
4. In the places where you usually smoke, clear away lighters, ashtrays, matches and
anything else that reminds you of cigarettes. Ask other smokers not to smoke aroundyou, and clean your house and car to remove the smell of cigarettes.
6. Avoid places where smokers gather. Go to places where smoking is not allowed, such
7. To calm the nervous energy you may feel, go for long walks,
take deep breaths of fresh air and keep your hands busy withthings such as gardening or crossword puzzles.
8. When the urge to smoke strikes, do something else. Call a
supportive friend, do brief exercises or go for a walk. Keeporal substitutes such as carrots, apples, raisins or gum handy.
9. Never think that “one won’t hurt.” It will.
Current Status of Outcome Measures in Vasculitis:Focus on Wegener’s Granulomatosis and MicroscopicPolyangiitis. Report from OMERACT 7PETER A. MERKEL, PHILIP SEO, PETER ARIES, TUHINA NEOGI, ALEXANDRA VILLA-FORTE, MAARTEN BOERS, DAVID CUTHBERTSON, DAVID T. FELSON, BERNHARD HELLMICH, GARY S. HOFFMAN,DAVID R. JAYNE, CEES G.M. KALLENBERG, JEFFREY KRISCHER, ALFRED MAHR, ERIC L. MATTESON,ULRICH SPECKS
Breathing therapies and bronchodilator use in asthma Thorax doi:10.1136/thx.2005.057422 Updated information and services can be found at: References This article cites 22 articles, 12 of which can be accessed free at: Email alerting Receive free email alerts when new articles cite this article - sign up in the box at theTo order reprints of this article go to: . . . . . . . . . .